Everything Trump Has and Hasn’t Done About Drug Prices

In contrast to the drugs, which are integral to our existence and the functioning of our bodies and our understanding of ourselves, the system by which we procure them is opaque and foreign to most people, even though everyone is constantly paying for drugs. Part of every American’s paycheck goes to Medicare, the largest buyer of drugs. And everyone is familiar with the drugstore itself, a sort of microcosm of the country’s drug-pricing problem.

Many of the largest pharmacy chains, such as Walgreens and CVS, explicitly brand themselves as bastions of health and/or wellness. Yet the pharmacy itself is always at the back of the store. Four of the top five most prescribed drugs in the U.S. are used to treat elements of metabolic syndrome—the constellation of high blood pressure, diabetes, and heart disease that is strongly tied to what we eat. But in order to get these medications, you have to walk past two aisles of candy (one seasonal). This is not to mention an onslaught of magazine covers of extremely thin, young people with eerily white teeth.

You can buy a whitening system for your teeth, too. And the coffee to stain them back. And the sleep aids to counteract the caffeine. If there is a unifying philosophy to drugstores, it is that they sell things that have a potential to produce profit. At the back of the store, the drugs that constitute some of the few products that are essential to life—such as insulin—are often not cheap. An annual supply of insulin in the U.S. costs more than in any other country, around $6,000. What’s more, from 2012 to 2016, the price roughly doubled—a textbook case of the pharmaceutical industry inexplicably increasing prices.

Insulin was the subject of congressional hearings last month that included the three biggest makers: Sanofi, Eli Lilly, and Novo Nordisk. Pharmaceutical companies traditionally justify high prices based on the costs of developing new drugs. In the case of insulin, the innovation that would justify such costs is not obvious. These companies did not invent or reconceptualize insulin. Some changes have been made to how long various insulin formulations last in the body, but there has been no revolution; the drug is an analogue of the hormone produced in the pancreas, similar to the insulin that was taken initially from pigs and given to humans a century ago.

Read: People are clamoring to buy old insulin pumps

Just before the hearing, Sanofi and Eli Lilly announced they would lower insulin prices (for some patients). Representatives called them out for only acting once called out. Joseph Kennedy was exasperated at the fact that this happened only after “15 years of global outcry.”

The drug companies gave a new, karmic defense: that others were now unfairly profiting off of them. They blamed high consumer costs on rebates being paid to a new layer of middlemen known as pharmacy benefit managers (PBMs). The three dominant PBMs—Express Scripts, OptumRx, and CVS Health—were also…